Online Complaint Intake Form
Complainant Information
Name
First Name
Last Name
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Please enter a valid phone number.
Email
example@example.com
Secondary Email
example@example.com
Description of Complaint
Narrative summary of complaint. Must include conduct alleged to be in violation of Article 14 of the Election Law and related Rules and Regulations.
Additional Information
To the extent known, please provide the following information:
Date of Violation
-
Month
-
Day
Year
Date
Date range, if applicable
Time of Violation
Hour Minutes
AM
PM
AM/PM Option
Place Where the Conduct Occurred
Witness Information
Please provide the information for any witnesses to the conduct (up to four).
Witness #1 Name
First Name
Last Name
Witness #1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Witness #1 Phone Number
Please enter a valid phone number.
Witness #2 Name
First Name
Last Name
Witness #2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Witness #2 Phone
Please enter a valid phone number.
Witness #3 Name
First Name
Last Name
Witness #3 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Witness #3 Phone Number
Please enter a valid phone number.
Witness #4 Name
First Name
Last Name
Witness #4 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Witness #4 Phone Number
Please enter a valid phone number.
All Documentary Evidence
Please upload all documentary evidence (e.g. receipts, records, emails, etc.) that you possess.
File Upload
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Date
-
Month
-
Day
Year
Date
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